Date of Award

Spring 5-27-2023

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

My Hanh (Theresa) Nguyen, PhD, PMHNP-BC


Background: Depression is one of the most common mental disorders in the United States. In 2020 alone, an estimated 21 million adults experienced at least one depressive episode, representing 8.4% of all U.S. adults. Transcranial magnetic stimulation (TMS) therapy is a cutting-edge option for treatment-resistant depression, and up to 70% of patients treated with TMS will achieve at least a 50% reduction in depression symptoms. For some, these results are long-lasting; for others, depression symptoms may return. For those who experience return of their depression symptoms, more TMS may be necessary. Currently, there is no standardized follow up procedure after patients finish a course of TMS to assess the need for more treatment sessions.

Purpose of Project: The purpose of this project is to implement a follow-up procedure for patients who are treated with TMS therapy.

PICO(T): How does implementing a standardized follow up procedure utilizing the PHQ-9 depression screening tool help to identify patients who need to return for retreatment or maintenance treatment 3 months after a course of TMS therapy?

Methods: The DNP student collaborated with the patient care team to implement a new follow-up procedure to identify patients who met criteria for maintenance treatment 3 months after their initial course of TMS. The procedure included administering the PHQ-9 depression screening tool, along with a telephone follow-up. Patients were considered for retreatment if the criteria for nonresponse was met (< 25% reduction in PHQ-9 score) or maintenance treatment if their 3-month PHQ-9 score and telephone interview indicated symptom relapse.

Results: Twelve patients were identified for follow-up. Three months after completing a course of TMS (40 sessions over the course of 5 days), 100% of patients filled out the PHQ-9 and 75% agreed to a follow-up phone call. Two patients were identified for further treatment.

Implications for Clinical Practice: Patient follow-up after a course of TMS can lead to early identification of depression symptoms, therefore leading to better patient outcomes.